Chemla D, Berthelot E, Assayag P, Attal P, Hervé P
Service de physiologie-hôpitaux universitaires Paris Sud-hôpital de Bicêtre, 94275, Le Kremlin Bicêtre, France; Faculté de médecine Paris-Sud, 94275, Le Kremlin-Bicêtre, France; Inserm UMR_S999, LabEx LERMIT, centre chirurgical Marie-Lannelongue, 92350 Le Plessis Robinson, France.
Service de cardiologie, hôpitaux universitaires Paris Sud-hôpital de Bicêtre, 94275 Le Kremlin Bicêtre, France.
Rev Mal Respir. 2018 Dec;35(10):1050-1062. doi: 10.1016/j.rmr.2017.10.667. Epub 2018 Jun 23.
The right ventricle (RV) plays a key role in the maintenance of an adequate cardiac output whatever the demand, and thus contributes to the optimization of the ventilation/perfusion ratio. The RV has a thin wall and it buffers the physiological increases in systemic venous return without causing a deleterious rise in right atrial pressure (RAP). The RV is coupled to the pulmonary circulation which is a low pressure, low resistance, high compliance system. In the healthy subject at rest, the contribution of the RV to right heart systolic function is surpassed by the contribution of both left ventricular contraction and the respiratory pump. RV systolic function plays a contributory role during exercise and in patients with pulmonary hypertension. The RV compensates better for volume overload than for pressure overload and is more capable of sustaining chronic increases in load than acute ones. An impaired RV-pulmonary artery coupling leads to a major mismatch between RV function and arterial load ("afterload mismatch") and is associated progressively with a low cardiac output and a high RAP. Right ventricular dysfunction is involved in the pathophysiology of both cardiovascular and pulmonary diseases, and may partly explain the deleterious haemodynamic consequences of mechanical ventilation.
无论需求如何，右心室（RV）在维持足够的心输出量方面起着关键作用，从而有助于优化通气/灌注比。右心室壁薄，它缓冲体循环静脉回流量的生理性增加，而不会导致右心房压力（RAP）有害性升高。右心室与肺循环相连，肺循环是一个低压、低阻力、高顺应性的系统。在静息状态下的健康受试者中，右心室对右心收缩功能的贡献被左心室收缩和呼吸泵的贡献所超越。右心室收缩功能在运动期间以及肺动脉高压患者中起辅助作用。右心室对容量超负荷的代偿比对压力超负荷更好，并且比急性负荷增加更能承受慢性负荷增加。右心室-肺动脉耦联受损会导致右心室功能与动脉负荷之间出现严重不匹配（“后负荷不匹配”），并逐渐与低心输出量和高RAP相关联。右心室功能障碍参与心血管疾病和肺部疾病的病理生理学过程，并且可能部分解释机械通气的有害血流动力学后果。
